Buzzy® Helps for Pain Management

Buzzy® is FDA cleared and indicated for control of injection pain, phlebotomy and IV pain, and pain from splinters, stings, myofascial trigger points, aches, injuries, and muscle soreness and stiffness.  Examples:  IVF, migraine, Crohn’s, blood thinner, psoriasis, and arthritis injections, pulled muscles, and more.

 

Pain Management
Pain relief has become a major focus of medical professionals in recent years.  While topical anesthetics have been around for decades and distraction has been proven to decrease distress by about 50%, these methods haven’t been accessible or taught to people who want to control pain themselves.  Briefly, to decrease pain, use other sensations that take bandwidth away from pain processing, optimize skin numbing with topical anesthetics and/or “gate theory” inhibition like Buzzy, and engage cognitive distraction to decrease fear.  Together, these techniques leave an empowered memory for even better tolerated subsequent procedures. 

The nature of procedural distress:

Many people learn to take injections without fear, and develop pride at being able to take care of their own health.  Because children get so many vaccinations today, some adults may have had negative experiences with needles – being held down, or being overwhelmed – difficulty with procedures is a big part of medicine.  Addressing procedural pain requires that all aspects of the experience be taken into account: the physical pain, the fear, and the focus on the event.
Distress:  The reaction to a painful event is a combination of physical pain, fear, and how much attention is paid to the experience.  When we pull a muscle running during a game, we may not even notice while focused on play.  At rest, fear and paying close attention can make the same physical pain feel much worse.  To make the experience of getting an injection as bearable as possible, the first few times it’s important to consider pain, fear, and focus to decrease distress. 
PAIN
Skin pain:  When the needle touches the skin there is pain.  Different people feel different levels of pain, based on how thick their skin is and genetic factors.  Fair-skinned and brown-eyed people may experience this pain more intensely.  To decrease skin pain, there are several options:
Topical anesthetics: Cream-based topical anesthetics are the most studied form of topical pain relief when time permits. For establishing a good pattern, your doctor may recommend a cream for the first few injection experiences.  Here are some pointers to maximize their effectiveness:

  • LMX-4®/ametop has a 4% lidocaine preparation encased in small skin-friendly molecules that can be rapidly absorbed. It has been well tested for injection pain and needle pain, and is effective in 20 - 30 minutes.  Put a 1-cm blob directly where the injection will go, then cover with a thin plastic medical barrier or a square of food wrap that will stick to the skin.  Leave in place at least 20 but no more than 30 minutes, as it will start wearing off.  One study presented at the Emergency Nurses Conference 2015 showed Buzzy® has equivalent pain relief.  IVs using Buzzy® were placed in 3.5 minutes compared to 40.5 minutes with LMX, at a fraction of the cost.
  • EMLA contains 2.5% lidocaine and 2.5% prilocaine, and is only available by prescription.  This cream’s pain relief begins around 60 minutes, deepening to 0.5cm over several hours.  Leave on no longer than 3 hours.  EMLA will vasoconstrict for the first hour, so don’t use it for IVs unless you have time.

Desensitization:  Use Buzzy® directly to desensitize the sensory nerves directly where you will be injecting.  While thicker skin, bigger body parts, and older children may need longer, 1 minute of desensitization should be enough for most body areas. 
Competing sensations: If you’ve ever bumped your elbow and rubbed it to stop the pain, you know how competing sensations can relieve pain.  To block pain, you can put other sensations – like rubbing, scratching, or cold-  closer to the brain DURING the injection.  Nerves run in pathways out from the spine, toward the belly button on the stomach, and down the arms and legs, curving slightly from the base of the spine diagonally across the thighs in front.  During the procedure, use your fingers to gently scratch or use a vibrating motor to massage the area between the brain and the injection pain.  In the stomach, put a sensation just lateral.  For procedures in the thigh, you want to stimulate the area diagonally closer to the hip.
These methods use something scientists call the “gate control” – slower nerve sensations of temperature or vibration “shut the gate” on the faster sharp pain sensations. When you bump your knee, rubbing it relieves the pain.  When you burn your hand, shaking it or running it under cold water decreases the pain. 

“Gate Control” relies on the fact that nerves that conduct pain (Adelta) run out of the back of the spine along side nerves for vibration (Ab) and temperature (c fibers).  The sensations these three bring back to the brain are interpreted in the spine into one primary message.  If the vibration or cold messages are intense, and the pain message gets diluted out.
For a burning injection, keep Buzzy® in place as long as they need do afterwards until the area feels normal.  Gate control requires continual stimulations, just like holding a burned finger under cool water only works as long as the finger is being cooled.  Take the finger out from under the water, and soon it will be hurting again.
Another example of Gate Control is recommended by the World Health Organization: stretching the skin where proximal to an injection.  Sometimes nurses will pinch and bunch up the muscle where an injections will go, which also has the effect of stretching the skin a little.  Stretching the skin just above the injection site may work even better.  Using two fingers, put them about one centimeter closer to the head than the shot goes, and stretch about two centimeters apart.

 

Mechanical pain:  Positioning of muscles matters
Tensed muscle fibers don’t move aside as a needle is inserted, so the fibers may experience more pain.  Relaxing the muscles helps – practice tensing then relaxing the muscles a few times in a non-healthcare environment.  By identifying the muscle to relax, it will be easier to do it during a procedure. 
Because muscles are stretched over joints like rubber bands, even when the muscle isn’t intentionally tensed some positions make muscles tighter than others.  For injections in the thigh, bending the knee even to 90 degrees will make the muscle more tense.  Sitting with a leg extended and nothing to push off/tense up against can help.  Since leaning forward can also pull those muscles (although to a lesser degree) you can experiment with different positions.  Some people giving themselves injections find lying down maximally relaxes thigh and gluteal muscles.
Medicine is physically taking up space, so studies show that slower injections and (believe it or not) wider gauges can decrease pain.  However for younger children, time is drama, so doing multiple injections faster may be better.

Changing Pain Processing

The brain processes pain in several different areas.  As we age, mildly unpleasant sensations (like bitter tastes or leaving your hand in an ice chest too long) will actually cause the brain to compensate by inhibiting unpleasant sensations everywhere.  For example, studies show that someone with their hand in an ice bath tolerates more pain other places on their bodies: the brain inhibits the obnoxious cold, and the sensation of cold takes up processing power that would otherwise be paying attention to pain.  Cold, vibration, and taste have been studied to see how they impact pain.  While the ways in which these sensations interact are complicated, for practical purposes pain relief can be simple.  Try to overload other sensations that take bandwidth away from pain processing.

Fingers have more nerves than stomachs or thighs, so sending the brain other sensory information from the hand can help decrease the amount of attention the brain pays to procedures elsewhere on the body. 
Take up physical bandwidth by wiggling, rubbing, or snappnig the fingers together during a procedure.  Alternately, do a task with the hand (for example, “tap each finger to the thumb four times”).  Another option is to hold something ice cold in the hand, or touch something textured reaching into a grab bag and trying to guess what it is – a piece of foil? Sandpaper?  A plastic car? Identifying a small item that is being held but not seen combines sensation, distraction, and challenge.

Fear
Pain alerts us to threats to our body, so it works in conjunction with fear.  You want your alarms to be most sensitive when danger is around, so if you are fearful pain is perceived more intensely.  To make procedures less painful, it’s important to decrease fear at any age.
Any first procedure creates an expectation for what you will experience going forward.  It’s not surprising that most people who fear needles recall an event at age 4-5 years involving needles, when verbal memory is well established and concrete fears of body integrity are at their highest. When someone already has a fear of needles, taking extra steps to prepare so the procedure experience is more positive. 
Before any procedure, gather any distraction aids or pain relief interventions, if for a child any rewards or behavior charts, or any comfort items before officially beginning the procedure.  Make sure the chair, couch, or bed is ready, that you have enough light, and that any extra people are available so the process will be smooth and calm.
For a pediatric procedure, the amount of anticipatory explanation depends on individual temperament and developmental stage.   Some general guidelines are that before age 6-8, children may not be able to understand abstract concepts like “this will keep you healthy.”  Instead, be concrete – “we need to take the medicine so your knee/elbow/hands don’t hurt/so you don’t get sick” or “stay feeling good”. Provide age appropriate explanation of what will happen to the child, and give a chance to ask questions. Use as many sensory descriptions to make the experience expected and concrete.
Language for pediatric patients:
Decrease Distress:

  • Praise: telling the child they’re doing a great job decreases distress
  • Encouragement:  “Awesome!  You’re almost done!”
  • Directive language when a child is getting upset: “Concentrate on that job we discussed – Find the monkeys, play with the squeeze ball”.
  • When discussing a procedure, use words the child doesn’t associate with pain
  • Bother Discomfort | Tight Squeeze | Pressure | Booster

Increase Distress:

  • “This won’t hurt” – lying increases distress, and causes children to be more distressed for later procedures that actually DON’T hurt (like removing an IV ).  Saying that a day is not an injection day and then surprising a child with the injection means that they won’t trust you on the other days.  Instead, you can offer to make a calendar so they will always know for themselves, or say you need to check if they need a booster first. 
  • “Does it hurt?”  While asking about the pain can seem caring, it causes the child to focus on the sensation, and implies that if it doesn’t now, it will hurt soon.  Children believe what they’re told to expect.
  • Apologizing and empathizing “It’s okay, honey, I know…” ironically increase distress, so be matter of fact.
  • Avoid words the child already associates with pain
    • Pain
    • Hurt
    • Stick
    • Sting
    • Shot

 

Being out of control causes fear.  Discuss with your doctor or nurse exactly what a procedure entails, and let them know what works best for you.  Ideally, ask “Will it be alright for you if we do the procedure the way we just discussed” so they commit.

While children can’t and shouldn’t control the experience, it is helpful if they have some parameters of the procedural experience that they control: where to sit; who is allowed in the room besides parents; what distraction they want (Book?  TV? Game? Pinwheel?); what special thing they do afterwards with you. 

  • Positioning for young children: even young children feel more vulnerable being held down flat.  It may make them more likely to fight, which tenses muscles.  Instead, use “position of comfort” – let a child sit in another adult’s lap, or with an adult next to them holding a comforting (and restraining) arm over their shoulder. 
  • Pride of accomplishment – everyone enjoys feeling brave.  Jumping off a rock and nailing the landing when no one is watching is much less fun than when people say “wow!”.  When other people are around to be impressed at your bravery, kids line up to jump!  Optimize the experience so your child gets the maximum pride in themselves.  On average, children show less distress when their fathers take them for vaccines; when they have a peer watching blood donation,  or when their sibling is told to watch and learn.
  • Collecting also gives pride in accomplishment: One program called “beads of courage” allows children with cancer to collect one specific bead for each procedure they undergo.  The ropes of beads are a testament to the tenacity and survival of these children.  One way to combat fear is to let a child earn something for each injection that they can collect.  Some systems have different colored stickers for how well they take their injections – as soon as they get 10 of the “well done!” stickers, they earn a special prize, but it’s important they also earn a prize just for total number.  This gives an incentive to take the injection well, but still recognizes that every time they get medicine that keeps them well is a victory.

 

Focus

Distraction pulls the processing component of pain elsewhere, so both the memory and experience of pain are less.  One study of children getting blood draws had them look at our DistrACTION® cards with monkeys doing silly things or hiding.  When parents asked the children questions during their blood draw, (How many monkeys have only three fingers?) the pain was reduced by half.  More importantly, 97% of these children said it was better than previous procedures. The Distraction Cards worked better than a Kaleidoscope in a different study, and better than two other methods of distraction in a third study.

To distract well, there should be a visual component and a challenge. Simply passively watching TV isn’t as effective as playing a video game.  Likewise, playing a traditional video game is not as effective as a 3-D virtual reality game.  iPad games involving touching to create cakes, designs, or to win relatively simple games are excellent sources of distraction.  Cognitive recall, asking a child to recount a story, or quizzing a child are less effective.

Even better is when there is a visual, a challenge and a sensory component.  One study found children did better when a vibration source was rubbed up and down their arm by the parent, with the child yelling “elbow!” each time it touched the elbow as a game.
Other advanced distraction and relaxation techniques for people of any age to try include counting anything – dots, ceiling tiles, letters in a sign.  Incorporating the natural relaxation of deep breathing also helps with both fear and focus: Blow a pinwheel, bubbles or a kazoo, or imagine a  Colored Cloud – hold a big breath, then imagines breathing a color out with the procedure.
Finally, controlling fear is easier when you have objectivity about the procedure, and feel that you are controlling some part of it.  Children requiring multiple procedures or chronic injections who are more scientifically oriented can compare different techniques to see what works.  After each procedure, they can rate their pain on a well validated scale (for example, the Faces Pain Scale –Revised. fps-rAs they experiment with things like taking a cold drink of something sweet while getting the shot, using Buzzy, blowing a pinwheel, they can rate what works best for THEM.  They;ll know that various techniques work better or don’t, and will appreciate how much each intervention or combination helps.

 

Injection Pain Management: PDFs by Dr. Amy with specific suggestions:  7 Secrets for Shots     Advanced Needle Fear   Topical Anesthesia Tips 
 
Children’s Pain Assessment Project Great Ormond Street Children’s Hospital: GREAT downloads! Pain management after surgery, pain management for toddlers…
www.natural-pain-relief-guide.com This natural pain relief guide provides the knowledge you need to understand the causes of pain. It gives natural solutions for quick and lasting relief by dealing with the cause of the pain. There are pages that cover various aspects of lifestyle and pages specifically for different types of pain.
How to help your child with JIA cope with procedures.

 


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